Acta chirurgica Scandinavica
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Pain from pancreatic cancer is, in most cases, both severe and debilitating. Large doses of morphine are sometimes not tolerated or accepted by the patient, and are often ineffective. It has been claimed that "coeliac plexus block is the simplest, most effective and least hazardous" means of palliation (49, 59); we think that this is true, and that coeliac plexus block should be considered more often than it is today, and at an earlier stage. Only in rare cases should pain from pancreatitis be treated with a nerve block.
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Twelve patients undergoing elective cholecystectomy received as analgesic medication a single dose of methylprednisolone (30 mg/kg) preoperatively and thoracic epidural analgesia with plain bupivacaine for 48 hours + epidural morphine 4 mg and systemic indomethacin 100 mg, both every 8 hours for 96 hours. Assessments of pain, various parameters of response to injury, peak flow and subjective fatigue were made preoperatively, before and 3 and 6 hours after skin incision and 1, 2, 4 and 8 days postoperatively. ⋯ There were no side effects. These results may be explained by inhibition of various trauma-induced inflammatory mediators.
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Of 72 patients who underwent jejunoileal bypass because of morbid obesity, 69 could be evaluated with special reference to long-term (median 11 years) results. One of the other three had fatal anastomotic leakage, one underwent resection and reversal of shunt because of postoperative gangrene in the bypassed segment, and one died of sepsis and liver failure following cholecystectomy 6 months after bypass. ⋯ Although jejunal bypass effectively reduces weight, the patients are at continuous risk of many complications. However, the improvement in quality of life should not be underestimated.
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Case Reports
Torsion of intra-abdominal lipoma--a rare cause of recurrent or acute abdominal pain. Case report.
Torsion of an intra-abdominal lipoma is a rare cause of abdominal pain. Two cases are presented--a 21-year-old woman with episodic abdominal pain for 3 years, and a 28-year-old woman with abdominal pain for 4 days before admission to hospital for mechanical small-bowel obstruction.